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A history of childhood sexual abuse overshadows all other factors that place a
woman at risk for contracting HIV infection, suggests a new UCLA and Charles R.
Drew University study. The American Journal of Health reports the findings in
its April issue.

The UCLA/Drew Women & Family Project followed 490 women in Los Angeles. Half of
the group was HIV-negative and half was HIV-positive. Each HIV-positive woman
was matched with an HIV-negative partner of similar ethnicity, age, and marital
and socioeconomic status. Over two years, the researchers interviewed each woman
in person every six months about her sexual behavior and disease management and
tested her for new sexually transmitted diseases.

Of the total women surveyed, UCLA researchers found that 49 percent were
sexually abused as children, 43 percent suffered sexual abuse as adults, and 41
percent were or had been in physically violent relationships.

"Sexual abuse before age 18 increased a woman's risk for becoming HIV-positive
more than any other factor," added Wyatt, a professor of psychiatry and
biobehavioral sciences at the UCLA Neuropsychiatric Institute. "This finding
crossed all racial and ethnic groups."

In addition to sexual abuse, HIV-positive women were more likely to possess less
years of formal education and to live in poverty than their HIV-negative
counterparts.

"Sexual abuse has its own unique effect on women's decision-making," Wyatt said.
"But abused women who live in poverty have greater difficulty moving on with
their lives. Their lack of economic resources severely restricts their choices.
This makes them dependent on men who continue to abuse them and put them at risk
for HIV."

Women who reported chronic childhood sexual abuse were seven times more likely
to engage in high-risk unprotected sexual behavior as adults. Most dramatically,
the number of HIV-positive women who had suffered rape doubled that of
HIV-negative women in all ethnic categories.

"We found that the same factors that increase a woman's risk for contracting HIV
might also contribute to her risk for rape and domestic abuse," said Wyatt.
"Relationships with coercive and abusive partners severely diminish a woman's
ability to negotiate safer sex."

According to Wyatt, few HIV-prevention programs address the effects of childhood
abuse on sexual risk-taking.

"You can't tell abused women to use condoms and 'just say no to drugs,'" Wyatt
stressed. "HIV service providers need to ask more questions about their
patients' sexual history. It may not be the number of partners that matters --
but the type of predatory person they gravitate toward.

"Those who use alcohol or drugs may be self-medicating to dull the pain of their
pasts," she added. "Physicians need to ask these women why they're doing what
they're doing."

"Because public health clinics treat more women of color with HIV, these
clinicians perceive the women as uncooperative if they don't change their
risk-taking behavior," explained Wyatt. "But they're missing the full picture.
White women with HIV don't go to public clinics as frequently because they can
afford private care."

Finally, says Wyatt, the healthcare system needs to consider offering
psychotherapy to everyone who needs it - not just those with the ability to pay.
As the UCLA/Drew study demonstrates, the inability to resolve childhood sexual
abuse measurably influences risky adult behavior -- which shapes AIDS epidemics.

"Sexual abuse will alter the course of anyone's life," said Wyatt. "The
after-effects don't go away by themselves. Most of these women didn't get help
after they were abused."

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